Annals for Hospitalists - June 2022
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJune 2022Annals for Hospitalists - June 2022FREEMegan Mack, MD*, Matthew Luzum, MD* and David H. Wesorick, MDMegan Mack, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author and David H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202206210 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesVenous Thromboembolism Prophylaxis in COVID-19: Making Sense of the Evidence—Christopher A. Smith, MD, and Geoffrey D. Barnes, MD, MScIn this month's commentary, the authors offer insight into the evolving evidence related to venous thromboembolism prophylaxis in patients with COVID-19.Highlights of Recent Articles From Annals of Internal MedicineSodium–Glucose Cotransporter-2 Inhibitors in Patients With Heart Failure: A Systematic Review and Meta-analysisAnn Intern Med. 2022;175:851-861. Published 12 April 2022. doi:10.7326/M21-4284This systematic review analyzed 8 randomized controlled trials (n = 15 022) comparing the effects of sodium–glucose cotransporter-2 (SGLT2) inhibitors to controls on death, hospitalization, kidney failure, and harms among adults with heart failure (with any ejection fraction). Most of the included studies were placebo controlled. Across comparators, SGLT2 inhibitors reduced hospitalization for heart failure by 37%, 32%, and 26% at 6, 12, and 24 months, respectively, and reduced cardiovascular death by 14% (95% CI, 1% to 25%) at 12 months. Sodium–glucose cotransporter-2 inhibitors also increased the risk for genital infections (risk ratio, 2.69). They did not affect symptoms of heart failure or rates of all-cause mortality or kidney failure.Key points for hospitalists include:Sodium–glucose cotransporter-2 inhibitors reduce hospitalizations and cardiovascular death in patients with heart failure, with the most dramatic reductions in hospitalization rates occurring early during therapy.Results were similar in patients with preserved or reduced ejection fractions and patients with or without diabetes.The authors advise that clinicians should periodically weigh the benefits of SGLT2 inhibitors against the ongoing risk for genital infections.International Validation of the Canadian Syncope Risk Score: A Cohort StudyAnn Intern Med. 2022;175:783-794. Published 26 April 2022. doi:10.7326/M21-2313This prospective cohort study (n = 2283) evaluated the external validity of the Canadian Syncope Risk Score (CSRS) in an international cohort (8 countries). The CSRS predicts the 30-day risk for serious clinical or procedural outcomes among adults presenting to an emergency department (ED) within 12 hours of syncope. Investigators compared the performance of the CSRS with that of another risk score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL). The CSRS categorized 60.8% (1388 of 2283) of patients as low or very low risk, compared with 48.4% (1104 of 2283) classified as low risk by the OESIL score. The rate of serious 30-day outcomes was lower among patients triaged as low or very low risk using the CSRS (15 of 1388 [1.1%]) compared with those triaged as low risk using the OESIL score (30 of 1104 [2.7%]).Key points for hospitalists include:In an international cohort of older patients with syncope, the CSRS accurately identified patients at low risk for serious outcomes and outperformed the OESIL score.The authors suggest that this could allow hospitals to avoid admission of some low-risk patients, although they point out that the optimal risk threshold for discharge of patients with syncope remains uncertain.In a multivariate analysis, performance of the CSRS was mainly driven by a single variable in the score (clinician classification of syncope as cardiac, vasovagal, or other). This variable alone did nearly as well as the full score, raising questions about the predictive value of the other variables in populations outside of the original derivation cohort.Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments: A Retrospective Cohort StudyAnn Intern Med. 2022;175:831-837. Published 15 March 2022. doi:10.7326/M22-0308This retrospective observational study compared patients infected with the COVID-19 Omicron variant (n = 898) with those infected with the Delta variant (n = 818) presenting to 13 Paris EDs from November 2021 to January 2022. Patients infected with the Omicron variant were younger (median age, 54 vs. 62 years), more likely to be vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), more likely to be discharged home from the ED (59% vs. 37%), and almost twice as likely to be found to have “incidental” COVID-19 while being admitted for another reason. Patients with Omicron were found to have less cough and dyspnea, lower levels of C-reactive protein, less lung involvement on imaging, and shorter lengths of stay. Compared with Delta, Omicron infection was associated with lower risk for intensive care unit admission (adjusted difference, 11.4 percentage points), mechanical ventilation (adjusted difference, 3.6 percentage points), and in-hospital mortality (adjusted difference, 4.2 percentage points).Key points for hospitalists include:This study shows that the SARS-CoV-2 Omicron variant, as compared with the Delta variant, is more likely to infect younger, vaccinated persons and is associated with better clinical outcomes, including lower rates of hospital admission, intensive care unit admission, and death.This study has several limitations. Only about half of patients presenting to the ED over the study period underwent variant determination. Also, some clinical variables were not well defined (e.g., overweight) and not all relevant data were available for all patients.The Latest Highlights From Journal ClubAre the COVID-19 messenger RNA vaccines associated with myocarditis?Moderna COVID-19 vaccine was linked to myocarditis or myopericarditis at 28 d (4.2 events/100 000 persons)Ann Intern Med. 2022;175:JC58. doi:10.7326/J22-0021This population-based cohort study in Denmark examined rates of myocarditis and myopericarditis in more than 4 million patients after receiving messenger RNA COVID-19 vaccines and found an elevated risk with the Moderna vaccine.For older patients undergoing hip fracture surgery, does the type of anesthesia affect delirium rates?In older adults having hip fracture surgery, regional vs. general anesthesia did not reduce postoperative deliriumAnn Intern Med. 2022;175:JC53. doi:10.7326/J22-0027In this randomized controlled trial from China, 950 adults aged 65 years or older undergoing surgical repair of a fragility hip fracture were randomly assigned to either regional or general anesthesia. Postoperative delirium rates did not differ between the 2 groups.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Disclosures:Authors have reported no disclosures of interest. Forms can be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3315.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Venous Thromboembolism Prophylaxis in COVID-19: Making Sense of the Evidence Christopher A. Smith and Geoffrey D. Barnes Metrics June 2022Volume 175, Issue 6Page: HO6 ePublished: 21 June 2022 Issue Published: June 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. 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